|
AMPUTATION - TOE; INTERPHALAN
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS 28825
|
| Hospital Charge Code |
76101044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
AMPUTATION, TOE; INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 28825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
AMPUTATION - TOE; INTERPHALA(P
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 28825
|
| Hospital Charge Code |
761P1044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$584.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.00
|
| Rate for Payer: Anthem Medicaid |
$166.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$735.00
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$466.89
|
| Rate for Payer: Healthspan PPO |
$710.95
|
| Rate for Payer: Humana Medicaid |
$166.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$506.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.50
|
| Rate for Payer: Molina Healthcare Passport |
$166.18
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$514.50
|
| Rate for Payer: UHCCP Medicaid |
$144.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.84
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
AMPUT THIGH-FEMUR REAMP
|
Facility
|
OP
|
$7,561.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
76100881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$982.93 |
| Max. Negotiated Rate |
$7,258.56 |
| Rate for Payer: Aetna Commercial |
$5,821.97
|
| Rate for Payer: Anthem Medicaid |
$2,600.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,897.58
|
| Rate for Payer: Cash Price |
$3,780.50
|
| Rate for Payer: Cigna Commercial |
$6,275.63
|
| Rate for Payer: First Health Commercial |
$7,182.95
|
| Rate for Payer: Humana Commercial |
$6,426.85
|
| Rate for Payer: Humana KY Medicaid |
$2,600.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,626.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,200.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,580.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,653.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,670.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$982.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,343.91
|
| Rate for Payer: PHCS Commercial |
$7,258.56
|
| Rate for Payer: United Healthcare All Payer |
$6,653.68
|
|
|
AMPUT THIGH-FEMUR REAMP
|
Professional
|
Both
|
$7,561.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
76100881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.76 |
| Max. Negotiated Rate |
$7,561.00 |
| Rate for Payer: Aetna Commercial |
$1,093.70
|
| Rate for Payer: Anthem Medicaid |
$514.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,561.00
|
| Rate for Payer: Cash Price |
$3,780.50
|
| Rate for Payer: Cash Price |
$3,780.50
|
| Rate for Payer: Cigna Commercial |
$1,182.65
|
| Rate for Payer: Healthspan PPO |
$990.65
|
| Rate for Payer: Humana Medicaid |
$514.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$931.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$525.06
|
| Rate for Payer: Molina Healthcare Passport |
$514.76
|
| Rate for Payer: Multiplan PHCS |
$4,536.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,292.70
|
| Rate for Payer: UHCCP Medicaid |
$2,646.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$519.91
|
|
|
AMPUT THIGH-FEMUR REAMP
|
Facility
|
IP
|
$7,561.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
76100881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$982.93 |
| Max. Negotiated Rate |
$7,258.56 |
| Rate for Payer: Aetna Commercial |
$5,821.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,897.58
|
| Rate for Payer: Cash Price |
$3,780.50
|
| Rate for Payer: Cigna Commercial |
$6,275.63
|
| Rate for Payer: First Health Commercial |
$7,182.95
|
| Rate for Payer: Humana Commercial |
$6,426.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,200.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,580.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,653.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,670.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$982.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,343.91
|
| Rate for Payer: PHCS Commercial |
$7,258.56
|
| Rate for Payer: United Healthcare All Payer |
$6,653.68
|
|
|
AMPUT THIGH-FEMUR REAMP(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
761P0881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.76 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,093.70
|
| Rate for Payer: Anthem Medicaid |
$514.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,182.65
|
| Rate for Payer: Healthspan PPO |
$990.65
|
| Rate for Payer: Humana Medicaid |
$514.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$931.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$525.06
|
| Rate for Payer: Molina Healthcare Passport |
$514.76
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$519.91
|
|
|
AMPUT THIGH-FEMUR REAMP(T
|
Facility
|
OP
|
$5,686.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
761T0881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.18 |
| Max. Negotiated Rate |
$5,458.56 |
| Rate for Payer: Aetna Commercial |
$4,378.22
|
| Rate for Payer: Anthem Medicaid |
$1,955.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,435.08
|
| Rate for Payer: Cash Price |
$2,843.00
|
| Rate for Payer: Cigna Commercial |
$4,719.38
|
| Rate for Payer: First Health Commercial |
$5,401.70
|
| Rate for Payer: Humana Commercial |
$4,833.10
|
| Rate for Payer: Humana KY Medicaid |
$1,955.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,975.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,662.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,196.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,705.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,994.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,003.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,264.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,137.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,762.66
|
| Rate for Payer: PHCS Commercial |
$5,458.56
|
| Rate for Payer: United Healthcare All Payer |
$5,003.68
|
|
|
AMPUT THIGH-FEMUR REAMP(T
|
Facility
|
IP
|
$5,686.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
761T0881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.18 |
| Max. Negotiated Rate |
$5,458.56 |
| Rate for Payer: Aetna Commercial |
$4,378.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,435.08
|
| Rate for Payer: Cash Price |
$2,843.00
|
| Rate for Payer: Cigna Commercial |
$4,719.38
|
| Rate for Payer: First Health Commercial |
$5,401.70
|
| Rate for Payer: Humana Commercial |
$4,833.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,662.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,196.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,705.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,003.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,264.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,137.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,762.66
|
| Rate for Payer: PHCS Commercial |
$5,458.56
|
| Rate for Payer: United Healthcare All Payer |
$5,003.68
|
|
|
AMVISC 1.2% SYR 9.6MG/0.8ML
|
Facility
|
IP
|
$561.56
|
|
|
Service Code
|
NDC 57770049565
|
| Hospital Charge Code |
25003825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Aetna Commercial |
$432.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.02
|
| Rate for Payer: Cash Price |
$280.78
|
| Rate for Payer: Cigna Commercial |
$466.09
|
| Rate for Payer: First Health Commercial |
$533.48
|
| Rate for Payer: Humana Commercial |
$477.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.17
|
| Rate for Payer: Ohio Health Group HMO |
$421.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.08
|
| Rate for Payer: PHCS Commercial |
$539.10
|
| Rate for Payer: United Healthcare All Payer |
$494.17
|
|
|
AMVISC 1.2% SYR 9.6MG/0.8ML
|
Facility
|
OP
|
$561.56
|
|
|
Service Code
|
NDC 57770049565
|
| Hospital Charge Code |
25003825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Aetna Commercial |
$432.40
|
| Rate for Payer: Anthem Medicaid |
$193.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.02
|
| Rate for Payer: Cash Price |
$280.78
|
| Rate for Payer: Cigna Commercial |
$466.09
|
| Rate for Payer: First Health Commercial |
$533.48
|
| Rate for Payer: Humana Commercial |
$477.33
|
| Rate for Payer: Humana KY Medicaid |
$193.12
|
| Rate for Payer: Kentucky WC Medicaid |
$195.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.17
|
| Rate for Payer: Ohio Health Group HMO |
$421.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.08
|
| Rate for Payer: PHCS Commercial |
$539.10
|
| Rate for Payer: United Healthcare All Payer |
$494.17
|
|
|
AMYLASE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
30000238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$6.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.48
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$6.48
|
| Rate for Payer: Humana Medicare Advantage |
$6.48
|
| Rate for Payer: Kentucky WC Medicaid |
$6.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
AMYLASE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
30000238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
ANA ANTI NUCLEAR ANTIBODY IFA
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
30000975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem Medicaid |
$12.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.09
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Humana KY Medicaid |
$12.09
|
| Rate for Payer: Humana Medicare Advantage |
$12.09
|
| Rate for Payer: Kentucky WC Medicaid |
$12.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.22
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
ANA ANTI NUCLEAR ANTIBODY IFA
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
30000975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.09
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.22
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
ANA ANTI NUCLEAR ANTIBODY IFA
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
30000975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$20.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$162.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: Healthspan PPO |
$12.67
|
| Rate for Payer: Multiplan PHCS |
$97.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.40
|
| Rate for Payer: UHCCP Medicaid |
$56.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.25
|
|
|
ANAEROBIC CULTURE
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
30001258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: Aetna Commercial |
$155.54
|
| Rate for Payer: Anthem Medicaid |
$9.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$162.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.47
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$167.66
|
| Rate for Payer: First Health Commercial |
$191.90
|
| Rate for Payer: Humana Commercial |
$171.70
|
| Rate for Payer: Humana KY Medicaid |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$9.47
|
| Rate for Payer: Kentucky WC Medicaid |
$9.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.76
|
| Rate for Payer: Ohio Health Group HMO |
$151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.62
|
| Rate for Payer: PHCS Commercial |
$193.92
|
| Rate for Payer: United Healthcare All Payer |
$177.76
|
|
|
ANAEROBIC CULTURE
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
30001258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: Aetna Commercial |
$155.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$162.21
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$167.66
|
| Rate for Payer: First Health Commercial |
$191.90
|
| Rate for Payer: Humana Commercial |
$171.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.76
|
| Rate for Payer: Ohio Health Group HMO |
$151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.62
|
| Rate for Payer: PHCS Commercial |
$193.92
|
| Rate for Payer: United Healthcare All Payer |
$177.76
|
|
|
ANAEROBIC CULTURE
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
30001258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna Commercial |
$13.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$8.38
|
| Rate for Payer: Healthspan PPO |
$9.92
|
| Rate for Payer: Multiplan PHCS |
$121.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$141.40
|
| Rate for Payer: UHCCP Medicaid |
$70.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.68
|
|
|
ANAFRANIL 50MG CAPSULE
|
Facility
|
IP
|
$4.87
|
|
|
Service Code
|
NDC 51672401206
|
| Hospital Charge Code |
25000223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
ANAFRANIL 50MG CAPSULE
|
Facility
|
OP
|
$4.87
|
|
|
Service Code
|
NDC 51672401206
|
| Hospital Charge Code |
25000223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
ANAFRANIL (CLOMIPRAM 25MG/1CAP
|
Facility
|
IP
|
$76.80
|
|
|
Service Code
|
NDC 406990603
|
| Hospital Charge Code |
25000222
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$73.73 |
| Rate for Payer: Aetna Commercial |
$59.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.90
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$63.74
|
| Rate for Payer: First Health Commercial |
$72.96
|
| Rate for Payer: Humana Commercial |
$65.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.58
|
| Rate for Payer: Ohio Health Group HMO |
$57.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.81
|
| Rate for Payer: PHCS Commercial |
$73.73
|
| Rate for Payer: United Healthcare All Payer |
$67.58
|
|
|
ANAFRANIL (CLOMIPRAM 25MG/1CAP
|
Facility
|
OP
|
$76.80
|
|
|
Service Code
|
NDC 406990603
|
| Hospital Charge Code |
25000222
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$73.73 |
| Rate for Payer: Aetna Commercial |
$59.14
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.90
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$63.74
|
| Rate for Payer: First Health Commercial |
$72.96
|
| Rate for Payer: Humana Commercial |
$65.28
|
| Rate for Payer: Humana KY Medicaid |
$26.41
|
| Rate for Payer: Kentucky WC Medicaid |
$26.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.58
|
| Rate for Payer: Ohio Health Group HMO |
$57.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.81
|
| Rate for Payer: PHCS Commercial |
$73.73
|
| Rate for Payer: United Healthcare All Payer |
$67.58
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 13668045301
|
| Hospital Charge Code |
25000224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
